Benefits And Eligibility Representative

MassHealth is seeking dynamic customer service-focused individuals to serve as a Benefits and Eligibility Representative. The successful candidate will be responsible for assisting individuals and families (including those individuals over the age of 65 residing in a nursing facility) with the application process by assisting and facilitating the necessary eligibility forms, reviewing continued eligibility, making referrals, and maintaining appropriate levels of benefits.

This position requires processing applications and other documents accurately, determining eligibility, meeting with members for case management, answering incoming calls, and representing the agency at hearings. Ideal candidates will display exceptional customer service and demonstrate an ability to successfully navigate a direct client-contact relationship.

Duties and Responsibilities (these duties are a general summary and not all inclusive):

• Assist individuals and families, individuals with disabilities, and others to determine initial and continued eligibility for MassHealth benefits.
• Provide quality customer service by responding to inquiries in a professional, efficient, and courteous manner.
• Provide requested services and appropriate referrals for customers to external programs for which they may qualify.
• Represent the agency at hearings and explain eligibility determinations.
• Validate customer demographic, financial, and background data.
• Validate customer demographic, financial, and background data through contacting applicants and collateral sources.
• Respond to customer inquiries and provide information regarding eligibility requirements.
• Assist members to navigate and complete online applications.
• Reconcile MassHealth case information with information from other agencies and sources.
• Process applications and administer case management via phone or in-person.
• Evaluate and review submitted documents to ensure accuracy and completeness of information.

Required Qualifications:

• Emotional Intelligence: Demonstrating self-control, persistence, integrity, and stress tolerance in difficult situations.
• Information Management: Evaluating information against standards and obtaining information from relevant sources.
• Adaptability: Being open to change and able to work in diverse environments.
• Active Listening: Listening to others and asking questions when needed.
• Dependability: Being reliable, responsible, and dependable in fulfilling obligations.
• Planning and Organization: Developing plans to accomplish work and prioritizing tasks.
• Interpersonal Skills: Developing constructive relationships with others, being service-oriented, and socially perceptive.
• Attention to Detail: Being meticulous and thorough in completing tasks.
• Communication Skills: The ability to understand and express information and ideas orally or in writing.
• Working with the Public: Dealing directly with clients and others who do business with the organization.

Preferred Qualifications:

• Experience working in a customer service or call center environment.
• Demonstrated ability to work independently and as part of a team.
• Proven experience working with individuals from diverse backgrounds, including those with disabilities, geriatric populations, non-English speakers, and low-income families.
• Ability to maintain strict confidentiality and handle sensitive information appropriately.
• Strong organizational skills and ability to manage multiple tasks simultaneously.
• Excellent communication skills, both oral and written, with the ability to explain complex information to customers in an understandable way.
• Proficient in Microsoft Office applications, including Word and Outlook.

About MassHealth:

MassHealth, the Commonwealth’s Medicaid program, provides health care benefits to certain low and medium-income Massachusetts residents. As an innovative national leader, the Commonwealth’s Medicaid program offers the opportunity to work with state-of-the-art technologies in a cutting-edge, fast-paced, call center environment.

The mission of MassHealth is to improve the health outcomes of our diverse members, their families, and their communities by providing access to integrated health care services that sustainably promote health, well-being, independence, and quality of life.

For more information about our agency and programs please visit: www.mass.gov/masshealth

Pre-Offer Process:

A criminal background check will be completed on the recommended candidate as required by the regulations set forth by the Executive Office of Health and Human Services prior to the candidate being hired. For more information, please visit http://www.mass.gov/hhs/cori

Education, licensure and certifications will be verified in accordance with the Human Resources Division’s Hiring Guidelines.

Education and license/certification information provided by the selected candidate(s) is subject to the Massachusetts Public Records Law and may be published on the Commonwealth’s website.

If you require assistance with the application/interview process and would like to request an ADA accommodation, please click on the link and complete the Reasonable Accommodation Online Request Form

For questions, please the contact the Office of Human Resources at 1-800-510-4122 and select option #2.

• One year of education equals 30 semester hours. Education toward a degree will be prorated on the basis of the proportion of the requirements actually completed.

Comprehensive Benefits

When you embark on a career with the Commonwealth, you are offered an outstanding suite of employee benefits that add to the overall value of your compensation package. We take pride in providing a work experience that supports you, your loved ones, and your future.

Want the specifics? Explore our Employee Benefits and Rewards!